Gov. Roy Cooper held a roundtable discussion about Medicaid expansion yesterday in Raleigh, and afterwords had a few comments for the media.
When asked about the price tag for expansion, specifically estimates from the John Locke Foundation projecting the costs to be $6 billion over the next ten years, Cooper offered this very slippery response:
“Completely wrong,” Governor Cooper said. “Right now, we can take Medicaid expansion from the federal government without any additional state tax dollars.”
This statement is designed to ease the minds of North Carolinians about Medicaid expansion’s costs, and certainly gives the impression that the full costs of expansion would be paid for by the federal government.
This is false.
It’s no secret that the federal government will pay for 90 percent of the costs of the expansion enrollees, and the state would have to pay for the remaining ten percent.
Indeed, Cooper’s own budget proposal for FY 2019-20 states on pg. 130:
Medicaid expansion requires no State dollars, as the federal government pays 90% of the costs and the rest is paid by hospitals and health plans, including the $3.3 million and $74.9 million shown as appropriations in this item
It’s quite ironic that Cooper’s budget claims that no state dollars are required for expansion, literally next to a budget entry showing close to $80 million in state appropriations over the biennium.
Now we must address the other part of Cooper’s misleading statement: that expansion will require “no State dollars”.
The bulk of the 10 percent state share of expansion costs, as noted in Cooper’s budget, would be “paid by hospitals and health plans.” With the first full year of expansion projected to cost $4.1 billion – according to Cooper’s budget – the state share would be roughly $410 million.
More specifically, as outlined in House Bill 5, entitled “Close the Coverage Gap,” hospitals will be taxed to pay the state share:
it is the intent of the General Assembly to enact legislation during the 2019 Regular Session that will replace the Hospital Provider Assessment Act in Article 7 of Chapter 108A of the General Statutes with a similar hospital provider assessment. In developing this similar hospital provider assessment, it is the intent of the General Assembly to further impose upon these same hospital providers a Medicaid Coverage Gap Assessment that will pay for the State share of the program and administrative costs associated with Medicaid expansion. (emphasis added)
Cooper is being intentionally coy with his wording, so to mislead the public. To pay for the bulk of the state share of expansion costs, there will be a new “assessment” (read: tax) levied on hospitals. Cooper tries to claim this doesn’t qualify as “state dollars.”
But who will collect the assessment? The state.
It’s hard to categorize this new funding stream as anything other than state dollars.
Moreover, this additional “assessment” levied on hospitals will likely be passed on to patients in the form of higher costs. But Cooper wants the public to think that Medicaid expansion is somehow “free,” so he uses intentionally misleading talking points.
Civitas polling has found that the more the public knows about Medicaid expansion in North Carolina, the less support it gets.
That’s a big reason behind Gov. Cooper’s attempt to hide the truth.